Peripheral retinal dystrophy. Peripheral chorioretinal degeneration. Cobblestone type

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Depending on which area of ​​the retina is affected, they are divided into three large groups:
1. Generalized retinal dystrophies;
2. Central retinal dystrophies;
3. Peripheral retinal dystrophies.

With central dystrophy, only the central part of the entire retina of the eye is affected. Since this central part of the retina is called macula, then the term is often used to denote dystrophy of the corresponding localization macular. Therefore, a synonym for the term “central retinal dystrophy” is the concept of “macular retinal dystrophy”.

In peripheral dystrophy, the edges of the retina are affected, while the central areas remain undamaged. With generalized retinal dystrophy, all parts of the retina are affected - both central and peripheral. A special case is age-related (senile) retinal dystrophy, which develops against the background of senile changes in the structure of microvessels. According to the location of the lesion, senile retinal dystrophy is central (macular).

Depending on the characteristics of tissue damage and the characteristics of the course of the disease, central, peripheral and generalized retinal dystrophies are divided into numerous varieties, which will be discussed separately.

Central retinal dystrophy - classification and brief description of varieties

• Stargardt's macular dystrophy;
• Yellow-spotted fundus (Franceschetti's disease);
• Best's vitelline (vitelliform) macular degeneration;
• Congenital cone retinal dystrophy;
• Colloid retinal dystrophy Doina;
• Age-related retinal degeneration (dry or wet macular degeneration);
• Central serous choriopathy.

Central chorioretinal retinal dystrophy

Due to the presence of effusion under the retina, a characteristic symptom of this dystrophy is a decrease in visual acuity and the appearance of wave-like curvatures of the image, as if a person is looking through a layer of water.

Macular (age-related) retinal degeneration

Both forms of macular degeneration of the retina develop in people over 50–60 years of age against the background of senile changes in the structure of the walls of microvessels. Against the background of age-related dystrophy, damage occurs to the vessels of the central part of the retina, the so-called macula, which provides high resolution, that is, allows a person to see and distinguish the smallest details of objects and the environment at close range. However, even with severe age-related dystrophy, complete blindness occurs extremely rarely, since the peripheral parts of the retina remain intact and allow a person to partially see. Preserved peripheral parts of the retina allow a person to navigate normally in his usual environment. In the most severe course of age-related retinal dystrophy, a person loses the ability to read and write.

Dry (non-exudative) age-related macular degeneration The retina is characterized by the accumulation of waste products of cells between the blood vessels and the retina itself. These waste products are not removed in a timely manner due to disruption of the structure and function of the microvessels of the eye. Waste products are chemicals that are deposited in the tissues under the retina and appear as small yellow bumps. These yellow tubercles are called Druze.

Dry retinal dystrophy accounts for up to 90% of cases of all macular degeneration and is a relatively benign form, since its course is slow, and therefore the decrease in visual acuity is also gradual. Non-exudative macular degeneration usually occurs in three successive stages:
1. The early stage of dry age-related macular degeneration of the retina is characterized by the presence of small drusen. At this stage, the person still sees well and is not bothered by any visual impairment;
2. The intermediate stage is characterized by the presence of either one large drusen or several small ones localized in the central part of the retina. These drusen reduce a person's field of vision, as a result of which he sometimes sees a spot in front of his eyes. The only symptom at this stage of age-related macular degeneration is the need for bright light for reading or writing;
3. The pronounced stage is characterized by the appearance of a spot in the field of vision, which is dark in color and large in size. This spot does not allow a person to see most of the surrounding picture.

Wet macular degeneration of the retina occurs in 10% of cases and has an unfavorable prognosis, since against its background, firstly, there is a very high risk of developing retinal detachment, and secondly, vision loss occurs very quickly. With this form of dystrophy, new blood vessels, which are normally absent, begin to actively grow under the retina of the eye. These vessels have a structure that is not typical for the eye, and therefore their membrane is easily damaged, and fluid and blood begin to leak through it, accumulating under the retina. This effusion is called exudate. As a result, exudate accumulates under the retina, which puts pressure on it and gradually peels off. That is why wet macular degeneration is dangerous due to retinal detachment.

With wet macular degeneration of the retina, a sharp and unexpected decrease in visual acuity occurs. If treatment is not started immediately, complete blindness may occur due to retinal detachment.

Peripheral retinal dystrophy - classification and general characteristics of types

Peripheral retinal dystrophies are often caused by changes in the length of the eye against the background of progressive myopia and deterioration of blood circulation in this area. As peripheral dystrophies progress, the retina becomes thinner, resulting in the formation of so-called tractions (areas of excessive tension). These tractions, if they exist for a long time, create the preconditions for a tear in the retina, through which the liquid part of the vitreous seeps under it, lifts it and gradually peels off.

Depending on the degree of danger of retinal detachment, as well as on the type of morphological changes, peripheral dystrophies are divided into the following types:

• Lattice retinal dystrophy;
• Retinal degeneration of the “snail traces” type;
• Frost-like degeneration of the retina;
• Cobblestone retinal degeneration;
• Small cystic degeneration of Blessin-Ivanov;
• Retinal pigmentary dystrophy;
• Pediatric Leber's taperetinal amaurosis;
• X-chromosomal juvenile retinoschisis.

Lattice retinal dystrophy

Most often (in 2/3 of cases) lattice retinal dystrophy is detected in men over 20 years of age, which indicates its hereditary nature. Lattice dystrophy affects one or both eyes with approximately equal frequency and then progresses slowly and gradually throughout a person's life.

With lattice dystrophy, white, narrow, wavy stripes are visible on the fundus, forming lattices or rope ladders. These stripes are formed by collapsed and hyaline-filled blood vessels. Between the collapsed vessels, areas of thinning of the retina are formed, which have the characteristic appearance of pinkish or red lesions. In these areas of the thinned retina, cysts or tears can form, leading to detachment. The vitreous body in the area adjacent to the area of ​​the retina with dystrophic changes is liquefied. And at the edges of the area of ​​dystrophy, the vitreous body, on the contrary, is very tightly fused to the retina. Because of this, areas of excessive tension on the retina (traction) arise, where small tears are formed that look like valves. It is through these valves that the liquid part of the vitreous penetrates under the retina and provokes its detachment.

Peripheral retinal dystrophy of the “snail traces” type

Frost-like retinal dystrophy

Retinal dystrophy "cobblestone"

Small cystic retinal dystrophy Blessin–Ivanov

Retinal pigmentary dystrophy

Pediatric Leber's taperetinal amaurosis

X-chromosomal juvenile retinoschisis

Congenital retinal dystrophy

• Pigmentary dystrophy;
• Leber's amaurosis;
• Nyctalopia (lack of night vision);
• Cone dysfunction syndrome, in which color perception is impaired or complete color blindness is present (a person sees everything as gray or black and white).

• Stargardt's disease;
• Best's disease;
• Age-related macular degeneration.

• X-chromosomal juvenile retinoschisis;
• Wagner's disease;
• Goldman-Favre disease.

Retinal dystrophy during pregnancy

If a woman had any eye diseases before pregnancy, for example, myopia, hemeralopia and others, this significantly increases the risk of developing retinal dystrophy during pregnancy. Since various eye diseases are widespread in the population, the development of retinal dystrophy in pregnant women is not uncommon. It is precisely because of the risk of dystrophy with subsequent retinal detachment that gynecologists refer pregnant women for consultation with an ophthalmologist. And for the same reason, women suffering from myopia need permission from an ophthalmologist to give birth naturally. If the ophthalmologist considers the risk of fulminant dystrophy and retinal detachment during childbirth to be too high, he will recommend a cesarean section.

Retinal dystrophy - causes

Local causative factors of retinal dystrophy include the following:

• Hereditary predisposition;
• Myopia of any severity;
• Inflammatory eye diseases;
• Previous eye surgeries.

• Hypertonic disease;
• Diabetes;
• Past viral infections;
• Intoxication of any nature (poisoning with poisons, alcohol, tobacco, bacterial toxins, etc.);
• Increased blood cholesterol levels;
• Deficiency of vitamins and minerals entering the body with food;
• Chronic diseases (heart, thyroid, etc.);
• Age-related changes in the structure of blood vessels;
• Frequent exposure to direct sunlight on the eyes;
• White skin and blue eyes.

Retinal dystrophy - symptoms and signs

• Decreased visual acuity in one or both eyes (the need for bright light for reading or writing is also a sign of decreased visual acuity);
• Narrowing of the field of view;
• The appearance of scotoma (spot or sensation of a curtain, fog or obstruction in front of the eyes);
• A distorted, wave-like image before the eyes, as if a person is looking through a layer of water;
• Poor vision in darkness or twilight (nyctalopia);
• Impaired color discrimination (colors are perceived as different, not corresponding to reality, for example, blue is seen as green, etc.);
• Periodic appearance of “floaters” or flashes before the eyes;
• Metamorphopsia (incorrect perception of everything related to the shape, color and location in space of a real object);
• Inability to correctly distinguish a moving object from a stationary one.

In addition to the listed clinical symptoms, retinal dystrophy is characterized by the following signs, identified during objective examinations and various tests:
1. Distortion of lines on Amsler test. This test involves a person looking with each eye in turn at a point located in the center of a grid drawn on a piece of paper. First, the paper is placed at arm's length from the eye, and then slowly brought closer. If the lines are distorted, this is a sign of macular degeneration of the retina (see Figure 1);


Figure 1 – Amsler test. At the top right is a picture seen by a person with normal vision. At the top and bottom left is the image that a person sees with retinal dystrophy.
2. Characteristic changes in the fundus (for example, drusen, cysts, etc.).
3. Reduced electroretinography readings.

Retinal dystrophy - photo

This photograph shows retinal dystrophy of the “cobblestone” type.

This photograph shows dry age-related macular degeneration of the retina.

Retinal dystrophy - treatment

General principles of treatment of various types of retinal dystrophy

Drug therapy for retinal dystrophy involves the use of the following groups of drugs:
1. Antiplatelet agents– drugs that reduce thrombus formation in blood vessels (for example, Ticlopidine, Clopidogrel, acetylsalicylic acid). These drugs are taken orally in tablet form or administered intravenously;
2. Vasodilators And angioprotectors – drugs that dilate and strengthen blood vessels (for example, No-shpa, Papaverine, Ascorutin, Complamin, etc.). The drugs are taken orally or administered intravenously;
3. Lipid-lowering drugs – drugs that lower blood cholesterol levels, for example, Methionine, Simvastatin, Atorvastatin, etc. The drugs are used only in people suffering from atherosclerosis;
4. Vitamin complexes , which contain elements important for the normal functioning of the eyes, for example, Okyuvit-lutein, Blueberry-forte, etc.;
5. B vitamins ;
6. Drugs that improve microcirculation , for example, Pentoxifylline. Typically, drugs are injected directly into the structures of the eye;
7. Polypeptides, obtained from the retina of cattle (the drug Retinolamine). The drug is injected into the structures of the eye;
8. Eye drops containing vitamins and biological substances that promote repair and improve metabolism, for example, Taufon, Emoxipin, Ophthalm-Katachrome, etc.;
9. Lucentis– a remedy that prevents the growth of pathological blood vessels. Used for the treatment of age-related macular degeneration of the retina.

The medications listed above are taken in courses, several times (at least twice) throughout the year.

In addition, for wet macular degeneration, Dexamethasone is injected into the eye, and Furosemide is administered intravenously. When hemorrhages develop in the eye, heparin, Etamsylate, aminocaproic acid or Prourokinase are administered intravenously in order to quickly resolve and stop it. To relieve swelling in any form of retinal dystrophy, Triamcinolone is injected directly into the eye.

The following physiotherapy methods are also used in courses for the treatment of retinal dystrophies:

• Electrophoresis with heparin, No-shpa and nicotinic acid;
• Photostimulation of the retina;
• Stimulation of the retina with low-energy laser radiation;
• Electrical stimulation of the retina;
• Intravenous laser blood irradiation (ILBI).

• Laser coagulation of the retina;
• Vitrectomy;
• Vaso-reconstructive operations (crossing the superficial temporal artery);
• Revascularization operations.

Approaches to the treatment of macular degeneration of the retina

If macular degeneration is in a more severe stage, then along with drug treatment, physiotherapy methods are used, such as:

• Magnetic stimulation of the retina;
• Retinal photostimulation;
• Laser stimulation of the retina;
• Electrical stimulation of the retina;
• Intravenous laser blood irradiation (ILBI);
• Surgeries to restore normal blood flow in the retina.

If a person has wet dystrophy, then first of all laser coagulation of sprouting, abnormal vessels is performed. During this procedure, a laser beam is directed to the affected areas of the retina, and under the influence of its powerful energy, blood vessels are sealed. As a result, fluid and blood stop sweating under the retina and peeling it off, which stops the progression of the disease. Laser coagulation of blood vessels is a short-term and completely painless procedure that can be performed in a clinic.

After laser coagulation, it is necessary to take drugs from the group of angiogenesis inhibitors, for example, Lucentis, which will inhibit the active growth of new, abnormal vessels, thereby stopping the progression of wet retinal macular degeneration. Lucentis should be taken continuously, and other medications should be taken in courses several times a year, as with dry macular degeneration.

Principles of treatment of peripheral retinal dystrophy

Retinal dystrophy - laser treatment

Examples of therapeutic treatment of dystrophy with a laser are retinal stimulation, during which the affected areas are irradiated in order to activate metabolic processes in them. Laser stimulation of the retina in most cases gives an excellent effect and allows you to stop the progression of the disease for a long time. An example of surgical laser treatment for dystrophy is coagulation of blood vessels or delimitation of the affected area of ​​the retina. In this case, the laser beam is directed to the affected areas of the retina and, under the influence of the released thermal energy, literally glues and seals the tissue and, thereby, delimits the treated area. As a result, the area of ​​the retina affected by dystrophy is isolated from other parts, which also makes it possible to stop the progression of the disease.

Retinal dystrophy - surgical treatment (operation)

Vitamins for retinal dystrophy

Vitamins for retinal dystrophy must be taken in two forms - in special tablets or multivitamin complexes, as well as in the form of food products rich in them. Fresh vegetables and fruits, cereals, nuts, etc. are richest in vitamins A, E and group B. Therefore, these products must be consumed by people suffering from retinal dystrophy, since they are sources of vitamins that improve the nutrition and functioning of the eyes.

Prevention of retinal dystrophy

• Do not overstrain your eyes, always give them rest;
• Do not work without eye protection from various harmful radiation;
• Do eye exercises;
• Eat well, including fresh vegetables and fruits in your diet, as they contain large amounts of vitamins and microelements necessary for the normal functioning of the eye;
• Take vitamins A, E and group B;
• Take zinc supplements.

Retinal dystrophy - folk remedies

Peripheral retinal dystrophy is one of the rare but quite dangerous diseases. If an illness occurs, the lack of timely medical care can lead to disastrous consequences, but proper treatment will help preserve vision. In addition, the problem can be difficult to diagnose and its analysis usually takes quite a long time.

Definition of disease

Peripheral retinal dystrophy usually refers to an eye disease (most often of a hereditary nature), the development of which is accompanied by processes of tissue destruction with subsequent deterioration of vision. In advanced stages, complete loss of vision is likely without the possibility of recovery (the same outcome is possible if ignored for a long time).

According to official statistics, up to forty percent of people with farsightedness and up to eight percent with myopia suffer from the disease.

For people with diseases of the visual organs, prevention and periodic examination are recommended for the possibility of acquiring retinal dystrophy.

The following forms of the disease are distinguished:

• Lattice. It is characterized by the appearance of white stripes, deterioration of blood circulation in the blood vessels of the eye and the formation of cysts. Often occurs against the background of retinal detachment.
• Retinoschisis. Characterized by retinal dissection, most often observed with the development of myopia. In most cases it is hereditary.
• Frost-like. It is characterized by the appearance of frost-like white inclusions on the front surface of the eye. Passed on by inheritance.
• With changes in the form of a snail trail. When the disease occurs, the appearance of perforated pathologies resembling a snail trail is observed. Often accompanied by tissue ruptures.
• With changes in the form of cobblestones. With the disease, pathologies in the form of oblong rings are observed, and pieces of pigment may be separated. Often diagnosed with myopia.
• Small cystic. Characterized by the appearance of a large number of red small cysts.

Causes

The disease can occur in people of any age and category. Among the most common causes of its occurrence are:

• Heredity (if relatives suffered from this type of problem);
• Traumatic brain injuries, eye damage;
• (less often – myopia);
• Injuries associated with excessive physical activity;
• Diabetes;
• Atherosclerosis;
• Cardiovascular diseases;
• Chronic diseases;
• Diabetes;
• Impaired blood supply to the organs of vision;
• Intoxication of the body.

The problem can also be caused by accumulated waste products in the body. Rarely, the disease develops during pregnancy.

Symptoms

In the first stages of the disease, most often there are no signs of its development. Most symptoms (with the exception of visible ones) are the same for each type of retinal dystrophy:

• (not always symmetrical);
• Veil, fog before the eyes;
• Incorrect perception of the shapes of objects in the surrounding reality;
• Fatigue, constant eye fatigue.

Sometimes symptoms can occur simultaneously, or they can occur separately or in sequence.

If abnormal fatigue of the visual organs occurs, it is recommended to consult an ophthalmologist for diagnosis for the development of retinal dystrophy.

Possible complications

If the disease is diagnosed early, its progression is stopped with treatment. The quality of the results of the intervention depends on the stage of development of dystrophy. In the absence of proper treatment, important tissues of the eye may be destroyed, complete or partial loss of vision (as happens during which we will look at next time) without the possibility of recovery. Retinal detachment is also possible.

Treatment

Currently, there are several methods. Their choice depends on the type and stage of the problem.

By medication

Treatment of the disease with medications gives positive results only in the early stages and in combination with other methods. Among the main drugs for procedures are:

• Vasoconstrictors;
• Angioprotectors;
• Means for strengthening blood vessels;
• Vitamin complexes.

Surgically

As a rule, surgical operations are indicated to improve blood supply and metabolism. However, the following procedures are most often carried out: Traditional methods will help prevent the irreversible consequences of peripheral dystrophy and improve the condition of the visual organs in general. However, they are recommended to be used only after consulting an ophthalmologist and as a complement to medical methods.

An infusion of Japanese sophora is used as such an additional remedy. Five grams of Sophora are mixed with half a liter of vodka and infused for three months. Use one teaspoon three times a day, after mixing with a small amount of water.

Prevention

The main preventive method for peripheral retinal dystrophy is periodic examination by an ophthalmologist. For those who have vision problems and frequent diseases of the visual organs, constant monitoring by a doctor is especially important. In addition, a healthy lifestyle, supporting the immune system and taking vitamin complexes are useful.

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conclusions

Peripheral is a rare but dangerous disease for health and vision. It is difficult to diagnose and cannot always be treated with complete recovery. However, its development can be easily prevented if you seek medical help as soon as the first symptoms appear, and its development can be stopped, thereby increasing the chances of maintaining vision.

The retina is a very important part of the eye; it perceives light and transmits it through itself, as a result of which a person can see an image. If there are disturbances in the vascular system, then a disease such as retinal dystrophy begins to develop.

The disease usually occurs in older people and is asymptomatic. During a standard examination, the peripheral zone cannot be seen, so digital devices or sclerocompression are used in diagnosis. It is advisable for all people over 40 years of age to undergo a full ophthalmological examination at least once a year.

The most common method of treating dystrophy is laser coagulation. In this article we will talk about peripheral retinal dystrophy, its types, forms of development, causes of occurrence and treatment methods.

Peripheral retinal dystrophy

The retina is the most important structure of the eye, which has a complex structure that allows it to perceive light impulses. The retina is responsible for the interaction between the optical system of the eye and the visual parts of the brain: it receives and transmits information.

Retinal dystrophy is usually caused by disorders in the vascular system of the eye.

It mainly affects older people, whose vision gradually deteriorates. With retinal dystrophy, the photoreceptor cells responsible for distance vision and color perception are affected. At first, retinal dystrophy can be asymptomatic and often a person does not even suspect that he has such an insidious disease.

The gradual process of destruction of the retina of the eye is called retinal dystrophy. As a rule, this pathology is associated with vascular disorders in the ocular structures.

A particular danger of peripheral dystrophy is that the early stages of the disease are usually asymptomatic. In addition, areas of the retina located in front of the equator of the eye are more difficult to examine, so when performing a fundus examination it is more difficult to detect peripheral dystrophy.

Retinal dystrophy is the gradual destruction of retinal tissue. Usually associated with disorders in the vascular system of the eye. With dystrophy, photoreceptors are affected, which leads to a gradual deterioration of vision. Peripheral dystrophy is especially dangerous because in the early stages the disease usually develops asymptomatically.

Peripheral dystrophy is more difficult to detect when examining the fundus of the eye, because the area in front of the equator of the eye is more difficult to examine. And it is this type of dystrophy that often unnoticed leads to retinal detachment.

Retinal dystrophy must be understood as a degenerative process, which is characterized by gradual destruction of retinal tissue. Most often, this pathology is associated with disorders in the vascular system of the fundus.

The peripheral zone of the retina is practically invisible during a routine standard fundus examination. But it is precisely on the periphery of the retina that dystrophic (degenerative) processes often develop, which are dangerous because they can lead to ruptures and retinal detachment.

Changes in the periphery of the fundus of the eye - peripheral retinal dystrophies - can occur in both nearsighted and farsighted people, as well as in people with normal vision.

Diagnosis of peripheral dystrophy is difficult, since changes in the fundus of the eye are not always clearly expressed, and the area in front of the equator of the eye is quite difficult to examine. That is why this type of dystrophy quite often leads to retinal detachment.

At-risk groups

Most often, peripheral retinal dystrophy occurs in myopic people. This is explained by the increased length of the eye in myopic people, which entails tension on the retina and its thinning. Elderly people (65 and older) are also at risk.

Often it is peripheral retinal dystrophy that is the cause of decreased vision in old age. This group should also include people with the following diseases: diabetes mellitus, hypertension, atherosclerosis and some others.

Patients with myopia (myopia) are most susceptible to developing peripheral dystrophy. This is due to the fact that with myopia the length of the eye increases, which leads to tension on the retina and its thinning.

The risk group also includes older people over 65 years of age. It should be noted that a very common cause of visual impairment in old age is peripheral retinal dystrophy.

In addition, the people most susceptible to this pathology include patients with diabetes mellitus, hypertension and atherosclerosis.

People suffering from myopia are more susceptible to retinal dystrophy. This can be explained by the fact that nearsighted people experience thinning and tension of the retina (due to elongation of the eye).

The main risk group includes older people (after 65 years). After all, it is peripheral retinal dystrophy that becomes the main cause of rapid decline in vision in old age.

This group includes people who have the following conditions:

• Arterial hypertension;
• Diabetes;
• Atherosclerosis.

Types of disease

Retinal dystrophies can be divided into:

1. Central and peripheral. Peripheral retinal dystrophy is most often present in myopic people. Reduced blood circulation in the eye with myopia leads to a deterioration in the delivery of oxygen and nutrients to the retina of the eye.
2. Congenital (genetically determined) and acquired.
3. “Senile” dystrophy develops most often after 60 years. This type of retinal dystrophy can be combined with the development of senile cataracts caused by the aging of the body.
4. Retinal pigmentary dystrophy is associated with disruption of the photoreceptors responsible for twilight vision. This type of retinal dystrophy is quite rare and is a hereditary disease.
5. White dot retinal dystrophy - usually occurs in childhood and progresses with age. This type of dystrophy is hereditary.

Depending on the nature of the damage, distinguish the following types of peripheral dystrophy:

• Lattice dystrophy. Usually inherited, men are most often affected. The lesion resembles a grate or rope ladder in appearance. As a rule, it affects both eyes at once. Often leads to retinal tears.
• "Snail trail" Dystrophic lesions form ribbon-like zones resembling snail tracks. May lead to large circular retinal tears.
• Frost-like. Usually hereditary, affects both eyes. Has characteristic yellowish-white inclusions on the retina.
• "Cobblestone pavement." The lesions are located far on the periphery, sometimes entire clumps of pigment are separated from them.
• Small cystic. It is distinguished by the presence of small cysts. More often occurs under the influence of injuries.
• Retinoschisis. Retinal dissection. It is more common in the elderly and nearsighted, and is sometimes inherited.

Depending on the size of the pathological process, it is customary to distinguish the following types of peripheral dystrophy:

1. Peripheral chorioretinal dystrophy (with this pathology, the lesion affects only the retina and choroid);
2. Peripheral vitreochorioretinal dystrophy (damage to the retina, vitreous body and choroid).

Lattice dystrophy is most often detected in patients with retinal detachment. A family-hereditary predisposition to this type of dystrophy is assumed to be more common in men.

As a rule, it is found in both eyes. It is most often localized in the upper outer quadrant of the fundus, equatorially or anterior to the equator of the eye.

When examining the fundus, lattice degeneration appears as a series of narrow white, fleecy stripes, forming figures resembling a lattice or a rope ladder. This is what obliterated retinal vessels look like.

Between these altered vessels, pinkish-red areas of retinal thinning, cysts and retinal breaks appear. Characteristic changes in pigmentation in the form of darker or lighter spots, pigmentation along the vessels. The vitreous body seems to be fixed to the edges of the dystrophy.

Dystrophy of the “snail track” type. The retina shows whitish, slightly shiny, streak-like inclusions with many small thinning and perforated defects.

Degenerative lesions merge and form ribbon-like zones, which in appearance resemble a snail's mark. Most often located in the upper outer quadrant. As a result of such dystrophy, large, round shaped tears can form.

Frost-like dystrophy is a hereditary disease of the retinal periphery. Changes in the fundus are usually bilateral and symmetrical.

On the periphery of the retina there are large yellowish-white inclusions in the form of “snow flakes”, which protrude above the surface of the retina and are usually located near thickened, partially obliterated vessels; there may be pigment spots.

Frost degeneration progresses over a long period of time and does not lead to rupture as often as ethmoid and trace cochlear degeneration.

Cobblestone degeneration is usually located far in the periphery. Individual white lesions are visible, slightly elongated in shape, around which small lumps of pigment are sometimes identified. Most often found in the lower parts of the fundus, although they can be detected along the entire perimeter.

Racemose (small cystic) retinal dystrophy is located at the extreme periphery of the fundus. Small cysts can merge to form larger ones.

In case of falls or blunt injuries, cysts may rupture, which can lead to the formation of perforated ruptures. When examining the fundus, cysts appear as multiple round or oval bright red formations.

Retinoschisis - retinal separation - can be congenital or acquired. More often this is a hereditary pathology - a malformation of the retina. Congenital forms of retinoschisis include congenital retinal cysts, X-chromosomal juvenile retinoschisis, when in patients, in addition to peripheral changes.

If there are also changes in the vitreous body, then tractions (cords, adhesions) are often formed between the changed vitreous body and the retina. These adhesions, joining one end to a thinned area of ​​the retina, greatly increase the risk of ruptures and subsequent retinal detachment.

PRHD and PVHRD - what is the difference?

Peripheral retinal dystrophies are divided into peripheral chorioretinal dystrophies (PCRD), when only the retina and choroid are affected, and peripheral vitreochorioretinal dystrophies (PVCRD), when the vitreous body is involved in the degenerative process.

There are other classifications of peripheral dystrophies that are used by ophthalmologists, for example, according to the localization of dystrophies or the degree of danger of retinal detachment.

Peripheral chorioretinal dystrophy of the retina. In this case, the retina and choroid are damaged. The disease usually develops in people over 50 years of age. With this type, people cannot read books or drive a car.

At the beginning of the disease, there are no symptoms, but then there is a distortion of straight lines, doubling of objects and the appearance of blind spots in the field of vision. In the advanced stage, complete loss of vision can occur.

Peripheral vitreochorioretinal dystrophy of the retina. Pvhrd of both eyes is a type of dystrophy in which the retina, the middle layer of the eye and the vitreous body are damaged so that detachment can even occur. Most often it occurs in people with myopia.

However, even with normal vision, heredity is an important factor. At the initial stage, symptoms do not appear in any way, and this pathology can only be detected using a three-mirror Goldmann lens.

Etiology and pathogenesis

Most often, the disease is caused by metabolic breakdown products that accumulate with age. A significant place is occupied by infections, intoxication and disruption of the blood supply to the inner membrane.

Retinal dystrophy can also develop in young people, due to pregnancy, cardiovascular diseases and pathologies of the endocrine glands.

Deterioration of blood flow in the peripheral parts leads to metabolic disorders in the retina and to the appearance of local functionally altered areas in which the retina is thinned. Against the background of retinal dystrophy and the formation of adhesions between the vitreous body and the retina, tension occurs in the thinned retina.

The retina ruptures at the site of tension, fluid enters the gap, which leads to retinal detachment.

The formation of tears is facilitated by physical activity, work associated with climbing to heights or diving under water, acceleration, carrying heavy objects, vibration, tilting the head, psycho-emotional stress, and excessive visual stress.

Complaints and clinical manifestations

Peripheral retinal dystrophy, as a rule, develops asymptomatically and is an incidental finding when an ophthalmologist examines the periphery of the fundus with a wide pupil. Only when the retina ruptures do the first complaints begin to appear.

Symptoms can be very different, but most often “flashes”, “lightning”, “glowing stars”, and the sudden appearance of more or less floating “flies” begin to appear before the eyes.

As mentioned above, the disease is characterized by a practically asymptomatic course with minor clinical manifestations. As a rule, it is discovered by chance during examination. If we talk about the first symptoms, they begin to appear mainly with retinal tears.

Causes

Often the disease is caused by metabolic breakdown products accumulated with age. Problems of blood supply to the inner membrane, intoxication, and infection play a significant role.

This disease can develop at a young age, against the background of pregnancy, pathologies of the endocrine glands and diseases of the cardiovascular system.

The causes of retinal dystrophy are different, but most of them are general diseases (diabetes mellitus, atherosclerosis, hypertension, kidney disease, adrenal glands) and local (myopia, uveitis), as well as genetic predisposition.

The causes of peripheral dystrophic changes in the retina are not fully understood. The occurrence of dystrophy is possible at any age, with equal probability in men and women.

There are many possible predisposing factors: hereditary, myopia of any degree, inflammatory eye diseases, traumatic brain injuries and injuries to the organ of vision. General diseases: hypertension, atherosclerosis, diabetes, intoxication, past infections.

The leading role in the occurrence of the disease is played by impaired blood supply to the peripheral parts of the retina. Deterioration of blood flow leads to metabolic disorders in the retina and to the appearance of local functionally altered areas in which the retina is thinned.

However, it has been proven that in people with myopia, peripheral degenerative changes in the retina are much more common, because With myopia, the length of the eye increases, resulting in stretching of its membranes and thinning of the retina at the periphery.

Symptoms of peripheral retinal dystrophy

The disease is dangerous because it develops almost asymptomatically. Very often it is found by chance during examination. The first symptoms begin to appear, as a rule, with retinal tears. These are, first of all, floating “spots” in front of the eyes, flashes.

For a long time, damage to the retina occurs without clinical manifestations. The pathology is characterized by a decrease in peripheral vision, which leads to difficult orientation in space.

Due to the fact that the field of vision narrows concentrically, patients can only perform certain types of visual work (reading, drawing). The function of central vision, provided there are no refractive errors, does not suffer.

In rare cases, patients complain of the appearance of floaters before the eyes or visual field defects in the form of scotomas. Symptoms such as lightning bolts or flashes of bright light indicate a retinal tear and require immediate attention.

Peripheral dystrophy is characterized by a unilateral course, but with the lattice variant, in most cases both eyes are affected.

Retinal tears

Based on their type, retinal tears are divided into perforated, valvular, and dialysis-type. Perforated tears most often occur as a result of ethmoid and carpal dystrophy; the hole in the retina gapes.

A rupture is called a valve rupture when a section of the retina covers the site of the rupture. Valvular tears are usually the result of vitreoretinal traction, which “pulls” the retina with it. When a tear forms, the area of ​​vitreoretinal traction will be the apex of the valve.

Dialysis is a linear tear of the retina along the dentate line - the site of attachment of the retina to the choroid. In most cases, dialysis is associated with blunt trauma to the eye.

Ruptures in the fundus look like bright red, clearly defined foci of various shapes, through which the pattern of the choroid is visible. Retinal breaks are especially noticeable against the gray background of detachment.

Diagnostics

Peripheral retinal dystrophies are dangerous because they are practically asymptomatic. Most often they are found by chance during examination. If there are risk factors, the detection of dystrophy may be the result of a thorough targeted examination.

There may be complaints about the appearance of lightning, flashes, or the sudden appearance of more or less floating flies, which may already indicate a retinal rupture.

A full diagnosis of peripheral dystrophy and “silent” tears (without retinal detachment) is possible by examining the fundus under conditions of maximum medical dilation of the pupil using a special three-mirror Goldmann lens, which allows you to see the outermost parts of the retina.

If necessary, compression of the sclera (sclerocompression) is used - the doctor, as it were, moves the retina from the periphery to the center, as a result of which some peripheral areas inaccessible for inspection become visible.

Today, there are also special digital devices with which you can obtain a color image of the periphery of the retina and, in the presence of zones of degeneration and ruptures, estimate their size relative to the area of ​​the entire fundus of the eye.

The peripheral area is hidden from observation during normal fundus examination. Traditionally, diagnosis of this area is carried out with maximum medical dilation of the pupil. The examination is carried out using a three-mirror Goldmann lens.

In some cases, sclerocompression (squeezing the sclera) will be needed. The procedure is not pleasant. Visual field testing, optical coherence tomography, electrophysiological studies, and ultrasound may also be used.

Examination of patients with suspected retinal dystrophy includes:

• determination of visual acuity;
• study of visual fields (perimetry) in order to assess the condition of the retina in its periphery;
• optical coherence tomography;
• electrophysiological study - determination of the viability of nerve cells of the retina and optic nerve;
• ultrasound examination of the internal structures of the eye - A-scan, B-scan;
• measurement of intraocular pressure (tonometry);
• fundus examination (ophthalmoscopy).

Treatment of peripheral dystrophy

The processes resulting in gradual destruction of the retina of the eyeball are called retinal dystrophy. In most cases, this anomaly is caused by a malfunction of the vascular structure. During the course of the disease, damage to the receptors begins, which leads to a gradual distortion of the quality of vision. Also, some areas of the retina are difficult to examine, making diagnosing the disease very difficult. This leads to the fact that the disease quietly develops into retinal detachment.

The main danger of PPRD (Peripheral Chorioretinal Dystrophy) of the retina is that it is quite difficult to identify it in the early stages of the disease.

Peripheral retinal dystrophy is most often diagnosed in patients suffering from myopia. This feature is explained by the fact that with myopia, the length of the eyeball increases. Because of this, the retina is stretched and its thickness becomes smaller. The risk group includes people who have reached old age.

This group also includes people suffering from diabetes, hypertension, and atherosclerosis. As a result of medical research, it was revealed that bad habits, poor diet and daily routine also play a significant role in the formation of the disease. There are often cases when the disease is hereditary.

It is on the periphery of the retina that dystrophic (degenerative) processes often develop

Classification of peripheral retinal dystrophy

There are quite a large number of subspecies of the disease. Based on the extent of involvement of the structure of the eyeball in the pathological process, two classifications can be created:

1. Peripheral chorioretinal retinal dystrophy (PCRD)– as a result of the disease, only the retinal area and the choroid of the eyeball are affected;
2. Peripheral vitreochorioretinal dystrophy (PVCRD)– during the course of the disease, the area of ​​the retina of the eye, blood vessels and vitreous body are affected.

Less commonly, the disease can be classified based on the nature of the damage:

1. Lattice dystrophy– a disease in which the affected areas take on the appearance of a rope ladder or grate. This pathology is hereditary in nature, and, as a rule, males suffer from it. The disease manifests itself in two eyeballs at once, and leads to retinal rupture.
2. "Snail Tracks"- especially the handwriting of this classification is expressed in the form of lesions that resemble a trace left by a snail. The band-like zones that appear in the initial stages lead to large circular tears in the retina.
3. "Cobblestone Pavement"- a rather unusual case when clumps of pigment accumulations appear on the outer part of the retina.
4. Frost-like dystrophy– during the development of the disease, yellow spots begin to form on the retina. The disease is hereditary and affects both eyeballs.
5. Small cystic dystrophy- is the result of previous trauma. The disease got its name due to the formation of small cysts on the affected areas.
6. Retinoschisis– in other words, separation of the retinal region of the eyeball. In rare cases, it is hereditary. It often appears in older people.

Causes

The main causes of the disease are considered to be the accumulation of metabolic breakdown products, the number of which increases with each passing year. The presence of infections, harmful toxins, and problematic blood circulation in the vessels of the inner lining of the retina can cause the appearance of the first symptoms of the disease. In representatives of the youth generation, the occurrence of the disease may be associated with problems in the endocrine glands, the cardiac vascular system and complications due to pregnancy.

Symptoms

The main problem of the disease is that its development is asymptomatic. In eighty percent of cases, it can be detected only during a routine examination by an ophthalmologist. The manifestation of obvious symptoms begins only in the later stages, when the retina ruptures. One of these signs may be the appearance of various kinds of flashes before the eyes and a disturbance in the acuity of perception.

Diagnostic methods

During a routine examination of the fundus of the eyeball, areas of the retina distant from the center are almost inaccessible for observation. To diagnose such areas, it is necessary to medicinally induce pupil enlargement. Only after this, using a special lens, can you begin the examination.

If retinal PCRD is suspected, a sclerocompression procedure may be necessary. In addition, the following procedures will not be superfluous:

• Ultrasound of the eyeball;
• EPI of the eyeball;
• optical tomography;
• visual field study.

Treatment

Today, three main methods are used to treat retinal CPRD: surgery, medication and laser therapy. However, all three methods are aimed at stabilization processes to compensate for the dystrophic process, and not at the complete restoration of visual functions. These methods can also be used to prevent possible rupture of the retinal area.

One of the most effective methods today is coagulation using a laser. As a result of the procedure, the lesions are welded together and create a kind of barrier that prevents further destruction of the retina. This operation can be performed on an outpatient basis, but before going to the laser surgeon’s office, you should familiarize yourself with its contraindications.

Forecast

Many experts say that stopping the progression of the disease is already a success. And this is true, because without proper medical care, the disease takes on a more complex form called “peripheral retinal degeneration.” This often leads to detachment of the retina, and sometimes to its rupture. If you seek the help of a specialist in a timely manner, many problems can be successfully solved, and most importantly, your vision can be saved.

In contact with

Eye retina (retina) It is the inner lining of the organs of vision and consists of light-sensitive photoreceptors and nerve cells. It is on this most important visual element that the clarity of the formation of the image received from the outside and transmitted to the brain depends.

There are two types of receptor cells located in the retina: rods and cones. The highly photosensitivity rods are responsible for peripheral vision and allow a person to see in the dark. In contrast, cones control central vision and require more light to function properly, which they use to recognize different colors and small details.

Retinal dystrophy - what is it?

Retinal dystrophy, also sometimes called retinal degeneration is a collective medical term that summarizes a whole group of ophthalmological pathologies that are inherited, arise independently (for example, with age) or develop as a result of the impact of other diseases on the organs of vision (for example, etc.).

Retinal dystrophy is usually a progressive and often irreversible painful condition, mainly manifesting in old age, but can also develop in young people and even children. Absolute loss of vision with this disease is extremely rare, but if the problem is ignored, such an outcome is quite possible.

Pathogenesis

Many pathological processes that form both inside the eye and in the human body as a whole can contribute to the emergence of a group of diseases called retinal dystrophy. Depending on the initial cause, during the development of this disease, destruction of the central or peripheral part of the tissue of the retina occurs first, and in some cases, atrophy affects the entire organ. This ultimately leads to a gradual decrease in the acuity of visual perception and the emergence of other negative visual symptoms. At first, this painful condition may be asymptomatic, which complicates its early detection.

With further progression of the disease, retinal degeneration occurs at the cellular level and primarily affects the photoreceptors of the eye, the functional purpose of which is to provide vision (especially distant vision) and organize the eye’s perception of natural colors. In this case, as a rule, both eyeballs are affected.

Initially, negative symptoms of dystrophy are found in one eye, and after some time (sometimes several years can pass), this process spreads to the second eye. Approximately 7-8 years from the onset of this disease, the patient experiences decreased vision in both organs of vision. Over time, retinal dystrophy can even cause disability.

Classification

All forms of retinal dystrophy have similar negative symptoms, which are united by the common process of progression of visual dysfunction and degenerative degeneration of retinal tissue. Today there are many varieties of this disease, which are most often classified depending on the main cause of its occurrence and localization in the eyeball.

According to the etiology of development, retinal dystrophies are divided into primary (hereditary) and secondary (acquired).

Hereditary dystrophies

Hereditary retinal dystrophies include those diseases that arise as a result of the patient’s genetic predisposition to their development, that is, inherited by his parents. These include dotted white and pigmentary dystrophies, Stargardt disease , Refsuma , Besta and many other pathologies of a similar nature, however, the first two are especially highlighted, since they are the ones that occur most often. As a rule, the symptoms of such dystrophies appear in childhood and increase as the child grows up.

Acquired dystrophies

Retinal dystrophies from this group mainly affect older people, but can also develop in children and adult patients who have suffered trauma to the eyeball or certain eye diseases. In adulthood, such forms of the disease often occur against the background of metabolic disorders in the tissues of the eye and/or in the presence of other age-related visual pathologies (for example,). In this group of dystrophies, age-related macular degeneration and serous choriopathy which are found most often.

In turn, depending on the concentration of the development of the pathological process in the retina, all dystrophies are divided into generalized, central and peripheral.

Generalized

In the generalized form of the disease, damage occurs to both the central and peripheral parts of the retina. Such dystrophies are divided according to the type of disturbance in the organs of vision, type of inheritance and modifications in the fundus.

Central

Central retinal dystrophy is characterized by disorders in the tissues of the eyeball occurring in its middle segment called macula , as a result of which pathologies of this nature are also called - macular degeneration . Diseases from this group are characterized by a classic ophthalmoscopic picture and their progressive course.

Peripheral

Peripheral retinal dystrophy mainly affects the edges of the optically passive part of the organ of vision, located near the dentate line. If, together with the retina, the vitreous body is involved in the pathological process and choroid (ocular choroid), then this pathology is called peripheral chorioretinal dystrophy . In the case when the disease also affects the vitreous body, it is called - vitreochorioretinal peripheral retinal dystrophy .

Below we describe the types of retinal dystrophy that ophthalmologists most often have to deal with.

White spot dystrophy

This form of dystrophy is a congenital disease and manifests itself in the patient from early childhood. As a rule, visual impairment in a child begins in preschool age and progresses irresistibly in the future.

Retinal pigmentary degeneration

The mechanism of development of pigmentary dystrophy, unfortunately, has not yet been fully studied, but it is known for certain that this disease appears as a result of a malfunction of the ocular photosensitive cells responsible for dark adaptation of vision. This disease occurs simultaneously in both eyes, proceeds rather slowly and manifests itself by alternating periods of exacerbation and transient relief. Most often, the first symptoms of pigmentary dystrophy begin to appear at school age, and by the age of 20 it is clearly diagnosed by an ophthalmologist and requires treatment. In this case, the patient already has and a narrowing of the visual field, which becomes tubular.

Central chorioretinal dystrophy

This disease is also called - serous choriopathy . It usually forms in men after 20 years of age due to the accumulation of effusion from the eye vessels directly under the retina. Such exudate interferes with the normal metabolism and nutrition of the retina, as a result of which its gradual atrophy develops. In addition, effusion over time contributes to retinal detachment, which in itself is a serious complication that can lead the patient to absolute blindness. A characteristic symptom of this dystrophy is the appearance in the field of view of image distortions of a wave-like nature, as if a person sees a picture through a layer of water.

Age-related retinal dystrophy

This type of dystrophy also refers to macular (central) dystrophy, and it was named age-related because it occurs mainly in older people after 50-60 years of age. This disease occurs in two basic clinical forms of development, namely:

• dry form (non-exudative);
• wet form (exudative).

Both of these forms develop under age-related changes that occur in the structure of the walls of the ocular microvessels. Against the background of this pathology, there is damage to the vascular structure in the central zone of the retina (macula), which is responsible for the high resolution performance of vision, which allows a person to notice and differentiate the smallest details of objects around him at close range.

However, even in the case of a severe course of this disease, the onset of complete blindness is extremely rare, since the peripheral parts of the patient’s retina remain intact, which gives him the opportunity to partially see and normally navigate in a familiar environment. The most severe course of age-related dystrophy leads to a person losing the ability to write and read.

Dry form

This type of dystrophy is characterized by the process of accumulation of cellular waste products among the blood vessels and the retina itself, which are not removed in time due to disruption of the microvascular structure and general functionality of the eye. These products from the activity of nearby cells are chemical substances that appear as small or large yellow bumps called drusen and are deposited in the tissue just under the retina.

The dry type of this dystrophy occurs in 90% of cases of all existing macular degeneration and is considered a relatively benign form of the disease, since it proceeds quite slowly, gradually reducing visual acuity over a long time.

There are three successive stages of development of non-exudative age-related macular degeneration:

• At an early stage, the presence of small drusen in the eye is noted. At the same time, the patient does not yet notice any visual impairment and sees well.
• In the intermediate stage, several small or one large drusen are found in the central part of the retina, which narrow the field of vision, as a result of which the patient sometimes observes a cloudy spot in front of the eyes. The only sign of the disease at this stage is the person's need for bright light used for writing or reading.
• When an advanced stage develops, a large dark spot is constantly present in the patient’s field of vision, which prevents him from seeing the vast majority of surrounding objects.

Wet form

The exudative type of macular degeneration is diagnosed in 10% of patients and is characterized by an unfavorable prognosis for its development, since it leads to rapid loss of vision and quite often causes retinal detachment.

In this form of the disease, new blood microvessels, which are normally absent, grow directly under the retina. The structure of these vessels is not typical for ocular tissues and therefore their walls are easily damaged, resulting in an effusion of exudate that accumulates under the retina. As a result of this process, the gradually accumulating exudate begins to put pressure on the retina, thereby promoting its detachment. Against the background of such drastic changes, there is a rapid deterioration in vision, which, if untimely and/or inadequate treatment, can result in complete blindness.

Lattice dystrophy

Of all the types of peripheral dystrophies, this vitreochorioretinal pathology ranks first in the likelihood of development and occurs in 63% of patients with a similar diagnosis. This type of disease is considered dangerous to health, since it provokes the greatest risk of retinal detachment. In two out of three cases, lattice dystrophy manifests itself in men after the age of 20, which in itself speaks in favor of its hereditary origin. This disease can affect one or two eyeballs with approximately equal frequency, after which it slowly progresses throughout the rest of life.

Examination of the fundus in lattice dystrophy reveals narrow, white, wavy stripes in the form of stairs or grids, which are formed by collapsed blood vessels filled with hyaline. Between them, areas of thinning of the retina are formed, which have a specific appearance of red or pinkish lesions. In these areas, breaks or cysts may occur, ultimately leading to retinal detachment. In addition, there is a liquefaction of the vitreous in the area of ​​its contact with the altered area of ​​the retina, and at the edges of the area of ​​dystrophy, on the contrary, their dense adhesion is observed. For this reason, zones of excessive tension, so-called traction, appear in the retina, which subsequently form valve-shaped small tears. It is through them that the liquid fraction of the vitreous body seeps under the retina, thereby provoking its detachment.

Dystrophy “Snail tracks”

This type of dystrophy is recorded by ophthalmologists in patients diagnosed with progressive dystrophy and is manifested by the appearance of perforated defects and streak-like inclusions on the surface of the retina. As a rule, all such damage is concentrated linearly and, upon examination, resembles a snail’s footprint left on the asphalt (in fact, for this reason, this pathology received its figurative name). Quite often, this dystrophy is accompanied by the formation of tears in the tissues of the eye, which can lead to retinal detachment.

Frost-like dystrophy

The frost-like type of dystrophy is a hereditary pathology and can affect both women and men. In this case, both eyes usually suffer simultaneously, and whitish or yellowish inclusions appear on the retina, similar in structure to snow flakes. Such lesions in most cases are located close to already thickened retinal microvessels.

Cobblestone dystrophy

Dystrophy called “Cobblestone pavement” mostly affects remote areas of the eyeball, directly located in the region of its equator. This type of disease is characterized by the appearance of individual pathological foci of white color on the retina, having an uneven surface and an elongated shape. Often these lesions have a circular arrangement. Patients with diabetes, as well as older people, are most susceptible to this type of dystrophy.

Small cystic dystrophy (Blessin-Ivanov disease)

As the name implies, small cystic dystrophy occurs due to the formation of small cysts in the peripheral areas of the fundus. Over time, areas of retinal separation and pinholes may appear in the area of ​​these growths. However, this type of dystrophy is characterized by a rather slow course and therefore has a favorable prognosis.

Tapetoretinal childhood amaurosis of Leber

Leber's amaurosis can develop at the age of 2-3 years and even in a newborn baby. When it occurs, the child experiences a sharp deterioration in visual perception, indicating the onset of the disease, and further slow progression of the pathology, sometimes over many years.

X-chromosomal juvenile retinoschisis

With this ophthalmological disease, retinal separation occurs simultaneously on both organs of vision. In the area of ​​such dissections, large cysts form, which are gradually filled with glial protein. Due to such deposits, radial lines (similar in shape to the spokes of a bicycle wheel) or star-shaped folds appear on the retina.

Other types of pathologies of this nature, such as Refsum's disease , peripapillary choroidal atrophy , nyctalopia and other similar diseases are relatively rare and are of interest only to a narrow circle of ophthalmologists.

Important! It should be remembered that the result of untimely or improper treatment of almost any type of dystrophic changes in the eyes will be retinal atrophy , which is likely to lead to absolute loss of vision.

What is retinal atrophy?

Translated from Greek the word “ atrophia" means starvation, that is, lack of food supply. In the context of ophthalmological diseases, retinal atrophy is a pathological process of reducing the volume of ocular tissues, characterized by a pronounced change in their cellular structure.

The cause of this pathology can be various eye diseases and, first of all, multiple dystrophies that disrupt adequate nutrition of the visual organs. Treating retinal atrophy is much more difficult than the initial visual impairment, and is often simply impossible. That is why in the treatment of eye diseases it is very important to diagnose the initially existing disease in time and try to eliminate it in the most effective way, since atrophy can have irreversible consequences leading to tissue death.

Causes

According to statistical data, confirmed by the results of many studies of this disease, it was found that retinal dystrophy “gets younger” every year, that is, it increasingly appears in middle-aged people. Today, not only elderly patients, but also people with bad habits and a hereditary predisposition to certain eye diseases are at risk of developing this pathology. Another serious circumstance contributing to the occurrence of retinal dystrophy has recently become an unfavorable environmental situation, which negatively affects all sense organs and in particular the eyes.

However, age is recognized as the main risk factor for retinal dystrophy, and the prevalence of this disease in patients under 60 years of age is only 1%, and after the age of 70 years – approximately 20%. It is for this reason that ophthalmologists recommend that all people at risk after 45 years of age undergo an annual examination of the state of their visual organs, which will help to notice an emerging problem in time and take adequate and timely measures to solve it. In addition, in 30-40% of cases, retinal dystrophy occurs in people with hypermetropia and in 2-3% of cases with normal vision. The total set of primary factors in the development of dystrophy can be figuratively divided into two main groups, namely general and local.

Common reasons for the formation of this group of diseases include:

• frequent exposure of the eyes to direct rays of the sun and other negative types of radiation;
• age-related vascular changes in the organs of vision;
• serious viral infections in the past;
• excessive plasma levels;
• various (poisoning with poisons, bacterial toxins, alcohol, etc.);
• severe chronic diseases (thyroid, heart, kidney, etc.);
• constant shortage of food intake minerals And .

Local causes of retinal dystrophy include:

• genetic predisposition;
• inflammatory eye pathologies;
• previous operations on the organs of vision;
• in any form of expression;
• previous eye injuries;
• present

Additional circumstances contributing to the earlier development of this pathology are tobacco smoking, as well as gender and race. It is known that people with white skin and blue eyes and women in general are more susceptible to retinal dystrophy. By and large, retinal dystrophy can be caused by any external or internal factors that disrupt blood flow and natural metabolism in the eyeball.

Symptoms of retinal dystrophy

At the initial stages of their development, most types of retinal dystrophy may not subjectively manifest themselves for a long time or be expressed very weakly. As a rule, the first clinical symptoms of this group of pathologies begin to bother the patient in the middle or even severe phases of the disease.

Despite the abundance of types of retinal dystrophies, their negative symptoms are largely similar to each other and are most often expressed by the following phenomena:

• limited field of view;
• weakening of visual acuity (may be in one or two eyes);
• the need for the presence of bright lighting used for writing or reading;
• the appearance of a wave-like distorted image before the eyes (reminiscent of the feeling of looking through a layer of water);
• appearance with a cat (various obstacles before the eyes in the form of spots, fog, curtains, etc.);
• development nyctalopia (decreased ability to see at dusk);
• problems with distinguishing colors (perception of colors that do not correspond to the real picture);
• periodic formation of flashes or “flies” before the eyes;
• inability to correctly identify a stationary object from a moving one;
• development metamorphopsia (distorted assessment by the visual organs of colors, shapes and locations of objects in real space).

If a person experiences any of the above symptoms, he should immediately contact a specialized specialist for a detailed examination and, if necessary, prescribe adequate treatment. It is not recommended to postpone your visit to the ophthalmologist for a long time, since without appropriate therapy, any retinal dystrophy can quickly progress and ultimately provoke its detachment, and therefore complete loss of vision.

Tests and diagnostics

Diagnosis of dystrophic changes in the retina requires a professional approach and a complete examination of the tissue structure of both organs of vision. In this case, it would be most appropriate to conduct a set of studies that will help accurately determine the existing disease.

When visiting a hospital, an ophthalmologist may prescribe the following diagnostic procedures and measures to the patient:

• general clinical tests;
• ophthalmoscopy (instrumental method of examining the fundus);
• perimetry (methodology for studying the marginal limits of peripheral vision);
• Amsler test (a method of diagnosing existing dystrophy using a grid drawn on paper with a dot);
• adaptometry (dark adaptation test);
• optical tomography of the retina;
• Ultrasound of the eyeball;
• biomicroscopy (detailed analysis of the tissue structure of the eye);
• visometry (a method of checking visual acuity based on the use of 4 special tables);
• fluorescein angiography (method of examination of ocular vessels with intravenous administration of organic pigment);
• refractometry (instrumental determination of ocular refraction);
• measurement ;
• assessment of color vision using the Rabkin table;
• electroretinography (technology for studying the functionality of the retina using light stimulation).

Treatment of retinal dystrophy

It is virtually impossible to completely eliminate the dystrophic changes in the retina that have already occurred using modern medicine, therefore any treatment for pathologies in this group is aimed at slowing down and/or stopping further progression of the disease and, in essence, is symptomatic.

In general, the therapeutic methods used in the treatment of retinal dystrophies can be divided into: medication, surgery and laser. Depending on the type of disease and the severity of its course, their separate or complex use in most cases makes it possible to stop the further development of the disease, reduce the severity of negative clinical symptoms and even partially improve visual function.

The doctors

Medicines

For drug therapy of various retinal dystrophies, it is practiced to prescribe drugs from the following drug groups:

• (mostly and and groups).
• Antiplatelet agents – medications that prevent vascular thrombus formation (, Ticlopidine , etc.). These drugs may be given as intravenous injections or tablets.
• Eye drops, including biological substances and vitamins that help improve material metabolism and repair of cellular structure (, etc.).
• Vasodilators And angioprotectors – medications that strengthen and dilate the vessels of the circulatory system (, Complamine , etc.). Can be administered intravenously or taken orally.
• Lipid-lowering drugs - drugs that reduce the content of plasma cholesterol (, etc.). Used only in patients with .
• Medications that enhance vascular microcirculation (,). Mostly, solutions of these drugs are used for injections into the eyes.
• Mineral and vitamin complexes containing elements important for the adequate functioning of the visual organs (, etc.).
• Polypeptides produced using bovine retinal tissue ( Retinolamine ). Injection directly into the eye structure is practiced.
• – a drug that inhibits the growth of new pathological vessels. Mainly used in the treatment of age-related retinal degeneration.

Treatment with all of the above medicinal drugs is usually carried out in courses that are carried out several times throughout the year (at least twice).

In addition, when treating wet macular degeneration, intravenous administration and intraocular administration are sometimes practiced. If there is hemorrhage in the eye, to stop it and resolve the hematoma, it is prescribed intravenously, Prourokinase or . In order to relieve swelling when treating any type of retinal dystrophy, they resort to injection into the eye.

Procedures and operations

Together with drug treatment, in order to correct vision and reduce the negative manifestations of retinal dystrophies, some physical therapy techniques can be used, namely:

• intravenous laser irradiation of blood;
• electrophoresis With , ;
• electrical stimulation retina;
• magnetotherapy ;
• retinal stimulation using low-energy laser radiation;
• photostimulation retina.

If there are indications for surgical operations, surgical intervention is possible, including:

• vitrectomy ;
• laser coagulation of the retina ;
• revascularizing operations;
• vasoreconstructive operations.

Principles of therapy for central retinal dystrophies

What to do with age-related retinal dystrophy and others? First of all, patients with such forms of the disease are recommended to undergo complex drug therapy, including a course of A, E and B, vasodilators , antiplatelet agents And angioprotectors . As a rule, courses of treatment with these groups of drugs are carried out at least 2 times every 12 months, which in most cases can significantly reduce the progression or even completely stop the development of the pathology, thereby maintaining vision at the existing level.

In the case when a patient is diagnosed with a more severe phase of macular degeneration, the above methods of physiotherapy are prescribed together with drug treatment or operations are performed to restore natural blood flow in the retina. The specific method of physiotherapy used should be selected by an ophthalmologist, based on the existing picture of the disease and its course. Along with taking medications, all physiotherapeutic procedures are also carried out in courses 2-4 times a year.

If the patient suffers from a wet form of dystrophy, then first of all he is shown laser coagulation , stopping the growth of abnormal blood vessels. During this procedure, the doctor directs a laser beam to the affected segments of the retina, where, under its powerful action, the so-called “sealing” of unnecessary vessels occurs. As a result of this manipulation, the exudate stops penetrating under the retina and exfoliating it, thereby stopping further progression of the disease. Laser coagulation itself is a short-term, painless and uncomplicated procedure, which is often carried out even in a regular clinic.

After laser coagulation, the patient must take angiogenesis inhibitors on an ongoing basis (, Makugen ), which will further inhibit the germination of new abnormal microvessels.

Principles of therapy for peripheral and generalized retinal dystrophies

Treatment of retinal pigmentary degeneration and other types of peripheral and generalized dystrophies primarily consists of proper surgical manipulations (usually, for such pathologies, the same laser coagulation and surgical delimitation of the area of ​​dystrophy are used), followed by regular medication and physiotherapeutic courses. When diagnosing peripheral dystrophy, the patient should protect his eyes from sunlight and be sure to stop smoking (if he has had this bad habit in the past).

Treatment of retinal dystrophies with laser

Method laser therapy It is widely used in the treatment of various forms of retinal dystrophy, since the directed laser beam has colossal energy, which allows it to have an effective effect on damaged areas of the eye without affecting its normal areas. Laser treatment is not a single type of operation that includes only one type of intervention, but rather represents a whole complex of different therapy techniques carried out using a laser beam.

An example of the effective therapeutic use of laser in the treatment of dystrophy is the retinal stimulation , the purpose of which is to activate metabolic processes in the eye tissues. During this procedure, only the affected areas of the eye are irradiated, which after completion in most cases regain some of the lost functions. A course of such laser stimulation is very effective and allows you to stop the development of the disease for a long time.

As a surgical instrument, a laser beam in ophthalmology is most often used to vascular coagulation or isolating the problem area of ​​the retina. During such operations, the thermal energy of the laser can literally “solder” damaged tissue, thereby preventing the disease from spreading further.

Surgical treatment of retinal dystrophies

Surgical interventions in the tissue of the eyeball are practiced only in cases of severe disease, when drug treatment and laser therapy are found to be ineffective. In the case of degenerative changes in the retina, ophthalmological operations can be divided into two types - vasoreconstructive and revascularizing.

• Vasoreconstructive operations are carried out using special transplants and are designed to restore the correct microvascular bed in the organs of vision.
• Revascularizing interventions are performed with the aim of eliminating pathologically overgrown microvessels and maximizing the opening of normal vessels.

Such surgical operations can only be performed by an experienced ophthalmologist and only in a hospital setting.

Treatment of retinal dystrophy with folk remedies

Treatment of retinal dystrophy with folk remedies can only be practiced in conjunction with the methods and drugs of official medicine, since this disease is considered quite severe and progressive. Folk remedies for the treatment of ocular retinal dystrophy include various vitamin and mineral mixtures that can provide the visual organs with the necessary natural substances that improve their nutrition and maintain functionality.

Among the folk recipes that are most conducive to eye health are the following:

• Wash the wheat grains and place them in a thin layer on the bottom of a suitable bowl, pouring a small amount of water on top. Place the wheat in a well-lit and warm place for faster germination. After green shoots appear, rinse the grains again and grind them using a meat grinder. Store the finished mass in the refrigerator, consuming it every morning in a volume of 14 tablespoons.
• Pour 1 tbsp. l. celandine with boiling water and boil the water over low heat for several minutes. After the decoction has cooled, you can drop 3 drops into your eyes three times a day for a month.
• Dissolve 50 g of mumiyo in 10 ml of fresh aloe juice and drop a few drops into your eyes twice a day. The prepared solution should be stored in the refrigerator and warmed to room temperature before the instillation procedure. This treatment can be continued for 9 days, after which it is necessary to take a break for at least a month.
• In a 1:1 ratio, mix goat milk (fresh) with boiled water. Place a couple of drops of this mixture in the affected eye, then cover it with a thick cloth for 30 minutes. The course of such treatment can last a maximum of a week.
• Mix 5 parts of pine needles with 2 parts of rose hips and 2 parts of onion peels, then pour boiling water over everything and boil for 10 minutes. Cool the resulting broth, strain and drink 0.5 liters per day for the next month, dividing this portion into several doses.

Prevention

Prevention of the occurrence of retinal dystrophies consists of following the simple rules below:

• Avoid eye strain and rest your eyes as often as possible.
• Practice eye gymnastics (close your eyes, “write” figure eights with them; move your gaze from a distant object to a near one; close your eyes tightly, and then open your eyes sharply and wide, etc.).
• Avoid exposing your eyes to harmful radiation, including sunlight.
• Take A, E and B groups.
• Eat nutritiously, trying to include as many fresh fruits and vegetables in your diet as possible.
• Get rid of excess weight.
• Give up bad habits and, first of all, smoking.
• Take zinc supplements.
• Get examined by an ophthalmologist annually.

In children

Since some forms of retinal dystrophy are hereditary, it is very important, if this pathology manifests itself in a family history, to promptly notice its development in the child. The risk of dystrophy in children is very high when it is inherited according to a dominant pattern, and its progression in this case occurs rapidly. This disease in a child usually develops in both eyes at once, and its most characteristic symptom is a violation of color perception. In addition to this, children may simultaneously experience a tremor of the eyeball and even the birth of the eyeball.

It should be remembered that to this day there are no effective medications that can completely cure this disease. That is why timely detection of this disease in a child and taking medical measures appropriate to the situation will greatly help to stop the pathological process and preserve vision.

During pregnancy

Diet for retinal dystrophy

There is no diet as such for retinal dystrophy, however, in order to prevent its development or reduce the progression of this disease, it is recommended to eat foods rich in minerals and vitamins that are beneficial to the eyes.

Forecast

As a rule, most forms of retinal dystrophy are diagnosed already in the later stages of their development and therefore the prognosis for the restoration of normal visual acuity in these pathologies is unfavorable. All drugs and techniques used to treat this disease are aimed at stopping its progression and maintaining vision at the existing level.

List of sources

• Astakhov Yu.S., Angelopulo T.V., Dzhaliashvili O.A. Eye diseases for general practitioners: A reference manual. – St. Petersburg; 2001.– pp. 147-150.
• Danilichev V.F. Modern ophthalmology. S-P.: Peter, 2000.- 668 p.
• Semenov A.D. Lasers in optical-reconstructive microsurgery of the eye: Dissertation... Dr. med. nauk.- M., 1994.-46 p.
• Fedorov S.N., Yartseva N.S., Ismankulov F.O. Eye diseases: A textbook for medical students. Universities.- M., 2005.-432 p.
• Katsnelson L.A., Forofonova T.N., Bunin A.Ya. Vascular diseases of the eyes. – M.: Medicine, 1990.-270 p.